Brophy Hannah, Tan Gaik Min, Yoxall Charles William
Neonatal Unit, Liverpool Womens Hospital, Liverpool L8 7SS, UK.
Children (Basel). 2022 Nov 7;9(11):1706. doi: 10.3390/children9111706.
National and international recommendations for thermal care at preterm birth include recommendations to avoid hypothermia and hyperthermia. There is limited evidence demonstrating harm resulting from admission hyperthermia. Our aim was to assess the relationships between admission temperature and outcomes in very low birth weight (VLBW) babies in a unit with low rates of hypothermia and a higher rate of hyperthermia. This was an observational study based on routinely collected data including demographics, admission temperature, survival and major morbidity outcomes. Subjects were 1104 consecutive inborn VLBW babies admitted to a Neonatal Intensive Care Unit in United Kingdom between 2010 and 2017. Results: 155 (14%) of babies were hypothermic (<36.5 °C) with only 21 (1.9%) < 36 °C, and 254 (23%) of babies were hyperthermic (>37.5 °C). The rate of major abnormality on cranial ultrasound scan was increased in the hyperthermic babies compared to the normothermic babies (37/239 (15.5%) vs. 54/601 (9%), relative risk (95% CI) 1.723 (1.166 to 2.546), p = 0.006). There was no difference in survival or other major morbidity in the hyperthermic babies compared to the normothermic babies. There was no association between hypothermia and survival or any major morbidity, although this probably reflects the low power of the study given the low rates of significant hypothermia. Higher admission temperature was associated with an increase in the risk of major cranial ultrasound abnormality using multiple logistic regression analysis (p = 0.007) with an increased odds ratio (95% CI) of 1.48 (1.11 to 1.97) for each degree of increase. We conclude that admission hyperthermia is independently associated with an increased risk of preterm brain injury. It is not possible to state whether this is a causative association, or whether the association is a consequence of a shared aetiology of perinatal infection.
国家和国际上关于早产时体温护理的建议包括避免体温过低和过高。仅有有限的证据表明入院时体温过高会造成危害。我们的目的是在一个体温过低发生率低且体温过高发生率高的单位中，评估极低出生体重（VLBW）婴儿入院时体温与预后之间的关系。这是一项基于常规收集数据的观察性研究，数据包括人口统计学信息、入院时体温、生存情况和主要发病结局。研究对象为2010年至2017年间连续入住英国一家新生儿重症监护病房的1104例出生时体重极低的活产婴儿。结果：155例（14%）婴儿体温过低（<36.5°C），其中只有21例（1.9%）<36°C，254例（23%）婴儿体温过高（>37.5°C）。与体温正常的婴儿相比，体温过高的婴儿头颅超声扫描显示主要异常的发生率更高（37/239（15.5%）对54/601（9%），相对风险（95%CI）1.723（1.166至2.546），p = 0.006）。与体温正常的婴儿相比，体温过高的婴儿在生存或其他主要发病方面没有差异。体温过低与生存或任何主要发病之间没有关联，不过鉴于显著体温过低的发生率较低，这可能反映出该研究的效能较低。使用多因素逻辑回归分析，入院时体温较高与头颅超声主要异常风险增加相关（p = 0.007），每升高1度，优势比（95%CI）增加1.48（1.11至1.97）。我们得出结论，入院时体温过高与早产脑损伤风险增加独立相关。无法确定这是否为因果关系，或者这种关联是否是围产期感染共同病因的结果。
